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How does this medication work? What will it do for me?

Ramipril belongs to the class of medications called angiotensin-converting enzyme (ACE) inhibitors. It is used alone and in combination with specific diuretics (water pills) to treat high blood pressure. Ramipril may also be used to reduce the risk of problems associated with heart disease (e.g., heart attack, stroke, or death) for people over 55 years old who are at a high risk of having these problems.

It is also given to certain people after heart attacks to improve survival and reduce the risk of hospitalization for heart failure. It works by relaxing blood vessels and by making the heart pump more efficiently.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

How should I use this medication?

The recommended adult dose of ramipril ranges from 2.5 mg to 10 mg daily in 1 or 2 divided doses, depending on the dose and circumstances. The maximum daily dose of this medication is 20 mg.

To treat high blood pressure, the usual starting dose for people not using diuretics (water pills) is 2.5 mg once daily. The dose is usually increased according to need every 2 weeks. The usual dose range is between 2.5 mg and 10 mg daily. For people using diuretics, your doctor may start with a lower dose of 1.25 mg daily or ask you to stop using the diuretic for 2 or 3 days before starting ramipril.

For people at increased risk of heart disease events, the recommended starting dose is 2.5 mg once daily, increasing gradually to 10 mg daily if tolerated.

For treatment following a heart attack, the usual starting dose varies depending on existing medical conditions, blood pressure, and other medications. The recommended starting dose is 2.5 mg twice daily, increased every 1 to 3 days if appropriate. The dose should not exceed 5 mg twice daily. A lower dose of 1.25 mg twice daily may be needed for those who experience low blood pressure as a result of taking the medication.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

What form(s) does this medication come in?

ratio-Ramipril is no longer being manufactured for sale in Canada. For brands that may still be available, search under ramipril. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

Who should NOT take this medication?

Do not take ramipril if you:

are allergic to ramipril, or any other ACE inhibitor, or any ingredients of the medication

are breast-feeding

are pregnant

have had angioedema (a serious allergic reaction which causes the area around the throat and tongue to swell)

have low blood pressure

have narrowing of the blood vessels to the kidneys

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

change in sense of taste

cough (dry, persistent)

diarrhea

dizziness or lightheadedness

drowsiness

flushing

headache

nausea

sexual difficulties

sleep difficulty

vomiting

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

balance problems

chest pain

confusion

fast heartbeat or palpitations

fever, muscle pain, rash, or swollen glands that occur in the first few weeks or month of treatment

low blood pressure (dizziness or lightheadedness, especially when rising from a lying or sitting position)

Stop taking the medication and seek immediate medical attention if any of the following occur:

abdominal pain, with or without nausea or vomiting

fainting

signs of an allergic reaction, including angioedema (shortness of breath or difficulty breathing; hives; swelling of the eyes, mouth, lips, or throat)

symptoms of a heart attack (pain, pressure, tightness or heaviness in the chest, jaw, neck or shoulder, sweating, or shortness of breath)

symptoms of a stroke (sudden numbness or weakness, especially on one side of the body; sudden confusion, trouble speaking, or difficulty understanding speech; sudden problems with coordination or balance; sudden vision problems in one or both eyes; sudden, severe headache with no other cause)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

HEALTH CANADA ADVISORY

February 4, 2014

Health Canada has issued new restrictions concerning the use of ramipril. To read the full Health Canada Advisory, visit Health Canada's web site at www.hc-sc.gc.ca.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Angioedema: Ramipril may cause a serious allergic reaction called angioedema, which may be fatal if not treated promptly. If you have difficulty breathing or notice hives or swelling of the face, lips, tongue, or throat, stop taking this medication and get emergency medical help at once. Other ACE inhibitors should not be taken in the future. People who have had angioedema caused by other substances may be at increased risk of angioedema while taking this medication.

Cough: People taking ramipril may develop a dry, persistent cough that usually disappears only after stopping or lowering the dose of ramipril.

Kidney function: Changes in kidney function have occurred in certain people who take this medication. The use of diuretics (water pills) may further increase the risk of kidney problems for those already at risk for this problem. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. People with kidney function impairment may require lower doses of this medication.

Liver function: This medication may cause liver problems. If you experience any signs of liver problems such as yellowing of the skin or eyes, fever, generally feeling unwell, abdominal pain, nausea, vomiting, loss of appetite, itching, muscle pain, rash, or swollen glands, contact your doctor immediately. If you have liver problems, you will need to be closely monitored by your doctor while taking this medication.

Low blood pressure: Occasionally, blood pressure drops too low after taking ramipril. This usually happens after the first or second dose or when the dose is increased. It is more likely to occur for those who take diuretics, have a salt-restricted diet, are on dialysis, have diarrhea, or are vomiting. To reduce the risk of dizziness, get up slowly from a lying or sitting position. If low blood pressure causes you to faint or feel lightheaded, contact a doctor.

Potassium: Increases in blood levels of potassium can occur with use of this medication. This rarely causes problems, but your doctor may want to monitor your potassium levels through blood tests.

Reduced alertness: This medication may reduce alertness, especially at the beginning of treatment. Do not drive or perform tasks that require alertness until you know how this medication affects you.

Pregnancy: ACE inhibitors such as ramipril may cause severe harm or death to the developing baby if taken by the mother during pregnancy. This medication should not be used during pregnancy. If you become pregnant while taking this medication, stop taking it immediately and contact your doctor.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking ramipril it may affect your baby. This medication is not recommended for breast-feeding women. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children. The use of ramipril by this age group is not recommended.

What other drugs could interact with this medication?

There may be an interaction between ramipril and any of the following:

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

stop taking one of the medications,

change one of the medications to another,

change how you are taking one or both of the medications, or

leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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Important Message

Any drug or natural health product may cause serious side effects or interactions with other medications.

Read the instructions, warnings and brochures provided by the manufacturer and consult your pharmacist when purchasing medication or natural health products carefully.

Always keep medications and natural health products out of the reach of children.

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